tbuckley/cabot-search huggingface dataset:
Abstract 12825: Merging Machine Learning and Patient Preference: A Contemporary, Comprehensive, Patient-Centered Tool for Risk Prediction Prior to Percutaneous Coronary Intervention
Authors: David E Hamilton, Jeremy Albright, Milan Seth, Devraj Sukul, Hitinder S Gurm
Journal: Circulation (2022)

Introduction Predicting personalized risk for adverse events following percutaneous coronary intervention (PCI) remains critical in weighing treatment options, employing risk-mitigation strategies, and enhancing shared decision-making. Hypothesis We hypothesized that by employing machine learning models, we would be able to use pre-procedural factors to predict common post-PCI complications. Methods A patient panel ranked the importance of common PCI complications. A separate group of 66 adults underwent a semiquantitative survey assessing for a preferred list of outcomes and model display. Our cohort included 71,963 PCI procedures performed at 48 hospitals in Michigan between 4/1/2018 and 9/30/2020 in the BMC2 registry divided into two groups for training (75%) and validation (25%). XGBoost and random forest models were created to predict the risk of in-hospital outcomes. Results The overall rate of mortality was 1.76% (n=1,264), AKI 2.64% (n=1,712), new need for dialysis 0.41% (n=295), major bleeding 0.89% (n=631), and transfusion 2.43% (n=1,746). The XGBoost model was selected as the final model and demonstrated excellent discrimination and calibration for all outcomes including mortality (AUC: 0.950 [95%CI 0.939-0.962]), AKI (AUC: 0.889 [95%CI 0.874-0.904]), dialysis (AUC: 0.949 [95%CI 0.928-0.969]), transfusion (AUC: 0.918 [95%CI 0.905-0.931]), and major bleeding (AUC: 0.892 [95%CI 0.861-0.922]). Survey subjects preferred a comprehensive list of individually reported post-procedure outcomes. Conclusion Using common pre-procedural risk factors, we designed an XGBoost machine learning model that accurately predicts individualized post-PCI outcomes. Utilizing patient feedback, we created a patient-centered tool to clearly display risks to patients and providers (Figure, shiny.bmc2.org/pci-prediction/). Enhanced risk prediction prior to PCI could help inform treatment selection and shared decision-making discussions.
Abstract 14827: Clinical Validation of a Novel Cuffless Portable Blood Pressure Measurement Device
Authors: Jeffery S Reynolds, Harsha Agashe, Eric D Peterson, Marc I Zemel
Journal: Circulation (2022)

Introduction: Ambulatory blood pressure (BP) measurements using an arm-cuff can be both cumbersome and painful; limiting patients’ willingness to obtain routine measurements. A novel, simple, rapid, cuffless device (TouchBP™) calculates systolic and diastolic BP based on observed blood volume oscillations that result from the variable finger pressure on a custom sensor pad. The accuracy of this novel device relative to cuff based standards is not known. Methods: An independent physiology lab compared a blind TouchBP™ reading to reference SBP and DBP measurements made via an experienced auscultator. Subsequent data from 6 subjects was excluded due to signal artifacts resulting in 52 subjects in the analysis dataset. The Digitouch prediction algorithm was created using data from two previous clinical studies with different subject pools. Results: Among 52 subjects, SBP ranged from 95 to 167 mmHg, and DBP ranged from 58 to 106 mmHg. The SBP estimation error was 0.4 ± 7.9 mmHg, while DBP error was 0.3 ± 7.2 mmHg [bias ± precision]. (See Figure 1). The bias and precision results meet accuracy thresholds established by AAMI standard (bias&lt; 5 mmHg and precision &lt; 8mmHg). Conclusion: Digitouch’s TouchBP™, a novel cuffless mobile BP measurement system produces accuracy results like traditional oscillometric cuffs.
Abstract 13119: Local Diastolic Dysfunction is Associated With Decreased Myocardial Viability in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Sabina Frljak, Gregor Poglajen, Andraz Cerar, Gregor Zemljic, Bojan Vrtovec
Journal: Circulation (2022)

Introduction. Although impaired global diastolic function is a key determinant of heart failure with preserved ejection fraction (HFpEF), the impact of local diastolic dysfunction is less clear. Hypothesis. We analyzed the distribution and myocardial viability correlates of local diastolic dysfunction in patients with HFpEF. Methods. We enrolled 30 patients with HFpEF (NYHA class III, LVEF &gt;50%, E/e' &gt;15, and NT-proBNP &gt;300 pg/ml) who were referred to our center for cell transplantation. Before transplantation, all patients underwent electroanatomical mapping; viable myocardium was defined as unipolar voltage (UV) ≥8.27 mV and non-viable myocardium was defined as UV &lt;8.27 mV. Local diastolic function was assessed by a novel algorithm based on the measurement of local mechanical diastolic delay (LMD). At each sampling point, LMD was measured as timing difference between global end diastolic time (based on left ventricular volume) and maximum local diastolic time (based on local wall movement of the mapping point). Results. Most of the patients were male (77%), with a mean age of 62±10 years, creatinine of 1.05±0.40 mg/dl, E/e’ of 18.0±3.5, and LVEF of 57.6±6.1%. Using electroanatomical mapping we generated a total of 4820 mapping points in 30 patients. The mean local mechanical diastolic delay was 47±33 msec, and the coefficient of variation was 0.70. The distribution of local mechanical diastolic delay in points with preserved myocardial viability and decreased myocardial viability is presented in Figure 1. We found a significant inverse correlation between UV and LMD (r= -0.18, P=0.001). Conclusions. In patients with HFpEF, areas of local diastolic dysfunction are unevenly distributed and appear so correlate with areas of decreased myocardial viability. Figure 1. Distribution of LMD in areas of decreased and preserved myocardial viability.
Abstract 13488: Strain versus Right Heart Catheterization in Decompensated Heart Failure With Preserved Ejection Fraction
Authors: Nathanael Tran, Mohammad Shaar, Hussein Al Sudani, Ramy Sedhom, Hamza Akhtar, Kevin Lo, Gregg S Pressman
Journal: Circulation (2022)

Background: Heart Failure (HF) is a complex cardiovascular (CV) disease with half of patients having preserved ejection fraction (HFpEF). Right heart catheterization (RHC) is often used to prognosticate and guide therapy in decompensated HFpEF while strain echocardiography is increasingly being used as an alternative modality. Purpose: To evaluate the prognostic impact of strain imaging compared to RHC in hospitalized patients with decompensated HFpEF. Methods: This was a retrospective cross-sectional study with patients hospitalized for acute HFpEF exacerbation with echo and RHC data available during index admission. Strain analysis was performed using 2D strain imaging software. Demographic and clinical parameters were obtained with mortality data via National Death Index. The outcomes of interest were 6 month, 1 year and 5 year all cause mortality and a composite of CV death with HF readmissions. Separate models incorporating all variables were done using survival analysis by multivariable Cox regression after adjusting for age, gender and race. Results: A total sample of 178 patients was included in the analysis. The mean age±SD was 69.4±13.5. Majority were African American (50%) and female (62%). Half(53%) had diabetes while 88% had hypertension. The 5 year all cause mortality rate was 45% with CV death at 18% and overall readmission rate was 29%. Only mean pulmonary artery pressure (mPAP) was significantly predictive of 6 month all cause mortality HR 2.01; 95% CI (1.07-3.78) p=0.031 and 5 year all cause mortality 1.91; 95% CI (1.46-2.51) p&lt;0.001. For the composite outcome of combined CV death and HF readmissions, right atrial reservoir strain was significant at the 6 month and 1 year time periods with HR 0.65; 95% CI (0.44-0.96) p=0.03 and HR 0.60; 95% CI (0.41-0.89) p=0.01 respectively. Conclusions: RHC and strain variables may be predictive of different outcomes in decompensated HFpEF.
Abstract 13493: Microalbuminuria During Acute Coronary Syndrome: Association With Very Long-Term Mortality and Causes of Death. The ABC-8* Study on Heart Disease
Authors: Giuseppe Berton, Heba T Mahmoud, Rocco Cordiano, Rosa Palmieri, Fiorella Cavuto, Moemen M Mahmoud, Nadir Sitta, David Merotto, Francesco Menegon, Paolo Palatini
Journal: Circulation (2022)

Background: Microalbuminuria is associated with adverse outcome in acute coronary syndrome (ACS) patients. Methods: To evaluate the very long-term association between microalbuminuria during ACS and the overall mortality and causes of death, we prospectively studied 579 ACS patients admitted to three Italian hospitals. The baseline albumin-to-creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24-h urine samples. Patients were followed for 22 years or until death. Results: Virtually all patients completed the follow-up, representing 6756 person-years. During follow-up, 449(78%) had died: 41% due to non-sudden cardiac death (non-SCD), 19% sudden cardiac death (SCD), 40% due to non-cardiac (non-CD) death. The unadjusted Cox regression analysis showed that ACR is a significant predictor of all-cause mortality (HR:1.26; 95%CI 1.22-1.31; p˂0.0001) and the 3 causes of death (HR:1.40; 95%CI 1.32-1.48; p˂0.0001), (HR:1.22; 95%CI 1.12-1.32; p˂0.0001) and (HR:1.16; 95%CI 1.09-1.23; p˂0.0001) for non-SCD, SCD and non-CD respectively. Yet the fully adjusted model showed that ACR is a significant independent predictor of all-cause mortality (HR:1.12; 95%CI 1.08-1.16; p˂0.0001) and only non-SCD (HR:1.21; 95%CI 1.14-1.29; p˂0.0001).A positive interaction between ACR and history of AMI (HR:1.15; 95%CI 1.03-1.29; p=0.01), and the presence of heart failure during admission (HR:1.11; 95%CI 1.01-1.24; p=0.04), and a negative interaction with LVEF (HR:0.89; 95%CI 0.80-0.99; p=0.03) for all-cause death was also observed at the multivariable level. Conclusion: This prospective study shows that baseline ACR during ACS seems to be a strong independent predictor of the very long-term mortality risk, chiefly associated with non-sudden cardiac death. A positive independent interaction with indicators of heart failure has been also observed. Figure 1: Relative hazard estimates for all-cause and cause-specific mortality 22 years after ACS according to baseline ACR.
Abstract 14200: Pacemaker Dependent Patients Can Be Discharged With Active Fix Temporary Pacemakers Following CIED Extraction for Infection
Authors: Duna Alkhalaileh, Anne Glover, Angela Krebsbach, Christopher Verdick, Uday Gajjandra Sandhu, Laith Alkukhun, Peter Jessel, Charles Henrikson
Journal: Circulation (2022)

Introduction: Management of infected CIEDs includes removal of the device with adjunctive antibiotic therapy. Temporary device management has historically consisted of a balloon-tipped temporary pacemaker (TPM). In recent years, TPMs with an externalized standard permanent pacing generator and an active fixation permanent pacing lead have become an alternative option to the balloon tipped pacemaker. These patients are typically kept in the hospital; however, this temporary pacing system is very secure, and with adequate social supports, these patients can be discharged. Methods: We reviewed data from patients who had CEID extraction between July 2012 and October 2021 at Oregon Health and Science University, and identified patients who were pacer dependent, underwent extraction for infection, and were discharged with an active fix TPM via the right internal jugular. Data for this study were collected prospectively in an IRB-approved clinical and research database for all patients undergoing lead extraction procedures. Results: A total of 14 individuals were identified between July 2012 and October 2021. Of the 14 patients identified, the majority were male (57.1%), had a median age of 71 years, and had systemic infections (92.9%). The mean length of hospitalization was 12 days, with a follow up visit occurring 5 days after discharge on average. One patient was lost to follow up following discharge with a plan for reimplantation at an outside hospital. The remaining 13 patients were seen weekly in pacer clinic for device and site checks. The total duration of TPM implantation ranged from 6 days to 153 days, with a mean of 36 days. There were no complications including systemic or local infection from TPM implantation or from reimplant of a new permanent device. Conclusions: Discharging patients with TPMs is a safe, cost saving, and well-tolerated option for pacemaker dependent individuals while they await reimplant of a new permanent device. The active fix TPM allows for antibiotics to be given at home, opens hospital beds, and relieves pressure to reimplant a permanent device as soon as possible.
Abstract 14206: Cross-Sectional, Exploratory Assessment of Biomarkers in Patients With Decompensated Heart Failure and Underlying Coronary Artery Disease (abide-hf)
Authors: RIck K Alleman, Frank A McGrew, Jayaprakash Kotha, Dominick J Angiolillo, John L Jefferies, Lisa K Jennings
Journal: Circulation (2022)

Introduction: Heart failure (HF) is a key contributor to high mortality and economic burden associated with cardiovascular diseases. Understanding the factors responsible for accelerated HF progression due to comorbid conditions is important in HF management. Hypothesis: The hypothesis of this study was that specific biomarkers related to thrombosis, inflammation, cardiac injury, and remodeling in patients with reduced ejection fraction (HFrEF) and coronary artery disease (CAD) may inform disease progression and aid in evaluating therapeutic efficacy. Methods: This study was a cross-sectional, exploratory assessment of biomarkers related to thrombosis, inflammation, and cardiac injury/remodeling in decompensated heart failure patients with reduced ejection fraction and underlying CAD. Symptomatic HF patients (n=74) with reduced left ventricular ejection fraction (LVEF ≤40%, HF ≥3 months) and significant underlying CAD as evidenced by previous myocardial infarction, prior coronary artery bypass graft, 50% coronary stenosis of one or more arteries, and history of percutaneous coronary intervention with or without stenting were enrolled in the study, and age-matched healthy subjects (n=20) were enrolled for comparative analysis of biomarkers. Results: Significant differences between HF+CAD and Controls were observed for thrombosis biomarkers (TM, p =0.0002, TGA [lag time, p =0.003; endogenous thrombin potential p =0.048], inflammatory biomarkers (CD62P, p =0.006; hsCRP, p= 0.0064; S100β, p =0.0004), and cardiac injury/remodeling (GDF-15, p =0.0002; NTproBNP, p &lt;0.0001). Conclusions: Elevated levels of hsCRP and GDF-15 demonstrate heightened systemic inflammation in HF and CAD, and support the hypothesis that targeting inflammation may provide additional treatment options for this patient population. A novel finding of this study was that S100β, previously identified to play a role in maladaptive compensatory mechanisms, was higher in HF+CAD patients and correlated with multiple biomarkers including, CD62P, NTproBNP, and TM. (ClinicalTrials.gov Identifier: NCT03551756).
Abstract 13657: Evaluating Outcomes of Half-Dose Tissue Plasminogen Activator on Patients With Intermediate-Risk Pulmonary Embolism: A Single Center Study
Authors: Zaid M Shahrori, Laith Alhuneafat, Sherin Sallam, ahmad jabri, Ahmad Al-Abdouh, Mohammed Mhanna, Adnan Yousaf, Yazan Abu omar, Mohamed Farhan Nasser, Aisha Siraj
Journal: Circulation (2022)

Introduction: In the absence of hypotension, pulmonary embolism (PE) causing right ventricular dysfunction or strain whether confirmed by imaging or cardiac biomarkers is deemed to be an intermediate-risk category. Urgent treatment of intermediate-risk PE can prevent progression to hemodynamic instability and death. Management options include thrombolysis, thrombectomy, or systemic anticoagulation. We aim to evaluate the short-term outcomes of a half-dose tissue plasminogen activator(tPA) for the management of intermediate-risk PE. Methods: We retrospectively identified adult patients diagnosed with intermediate-risk PE between the years 2000 and 2021. Demographic data, lab values, imaging, treatment choice, and outcomes were all obtained through chart review. Patients on standard systemic anticoagulation without thrombolysis or thrombectomy served as controls. Data analysis was done through SAS® Software (version 9.4; Cary, NC) to compare those that received half-dose tPA with controls and statistical significance was set at a p-value of 0.05. Results: We included 57 patients in our final analysis with 19 receiving tPA. Patient characteristics and comorbidities were comparable between both groups. There was a significant difference between PE location, presence of acute deep vein thrombosis, and peak troponin level between both groups (Table 1). The thrombolytic cohort was more likely to have a 60/60 sign and a thrombus in transit on echocardiography than controls. The thrombolytic group was more likely to have major bleeding (17% vs 7.9%, p= 0.4) and in-hospital mortality (5.3% vs 0%, p=0.3), however, this was not statistically significant. Conclusion Patients who received half-dose tPA had non-significant higher rates of major bleeding and in-hospital mortality. Larger scale, randomized control trials are needed to establish the benefit and safety of thrombolytics in patients with intermediate-risk PE.
Abstract 14901: Risk Factors for Cardiotoxicity in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Systematic Review With Meta-Analysis
Authors: Chin-Hsuan Huang, Eahab Abdul-lattif, Muneeba Azmat, Yu Chang, YU SHIUAN LIN, Michele Nanna, MD, FACC, Kuan Yu Chi
Journal: Circulation (2022)

Introduction Although immune checkpoint inhibitors (ICI) have reshaped the treatment landscape for cancer patients, they carry potential risk for the development of cardiovascular adverse events (CVAEs). Objectives We attempted to identify risk factors for CVAEs in cancer patients receiving ICI. Methods Two investigators (C.H.H. and Y.C.) independently reviewed Medline, PubMed, and Embase from inception to May 20, 2022 to identify high quality studies. We included randomized controlled trials, prospective or retrospective cohorts that reported the risks factors for any new onset or worsening CVAEs, including cardiomyopathy, arrhythmia, heart failure, acute coronary syndrome, myocarditis, and pericarditis, in cancer patients receiving ICI. Two investigators (E.A. and M.A.) independently extracted data from included studies. Any discrepancy was resolved through discussion with senior reviewers (K.Y.C and M.N.). We performed random-effects meta-analyses on risk factors for CVAEs after the initiation of ICI. We used I-statistics (I 2 ) to quantify the statistical heterogeneity. Results 12 observational studies involving 21,912 patients (CVAEs=2,897) of any cancers were included for final qualitative and quantitative analyses. 11 covariates, including age, gender, body mass index, ever-smoking history, hypertension, type II diabetes, coronary artery disease (CAD), congestive heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, and stroke, were available for the meta-analyses. Our meta-analyses (Table 1) demonstrated that male gender, hypertension, CAD, and CKD were associated with increased odds for the development of CVAEs in patients taking ICI. Conclusions In conclusion, male gender, hypertension, CAD, and CKD were identified as significant risk factors for CVAEs in patients taking ICI. Evidence supports a strategy of proper optimization of risk factors before, during, and after the ICI treatment.
Abstract 14871: Ambulatory Cardiac Rhythm Monitoring in Individuals With Chronic Kidney Disease
Authors: Rajat Deo, Jingrong Yang, Francis E Marchlinski, Elsayed Z Soliman, Wei Yang, Haochang Shou, Dawei Xie, Hsiang-Yu H Chen, Matthew R Weir, James Lash, Rupal Mehta, Natalie Meza, Vallabh Shah, mark L unruh, Robert Nelson, Jing Chen, Jiang He, Lawrence J Appel, Bernard Jaar, Nisha Bansal, Alan S Go
Journal: Circulation (2022)

Introduction: Chronic kidney disease (CKD) is associated with arrhythmias such as atrial fibrillation (AF) and sudden cardiac death, but limited rigorous data exist on the prevalence of AF, ventricular tachycardia (VT), nonsustained VT (NSVT), and high-degree atrioventricular (AV) block in a CKD cohort. Hypothesis: In participants with CKD, worse kidney function is associated with a higher burden of atrial and ventricular arrhythmias. Methods: We evaluated the prevalence of AF, VT, NSVT, and high degree AV block in participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who underwent monitoring using the ZIO XT patch, a noninvasive, 14-day continuous single-lead electrocardiogram monitor. We evaluated patient characteristics and the association between kidney function and each arrhythmia. Results: Among 1182 participants (mean age 69±9 years; 48% women), mean patch wear time was 11.9±3.8 days, and mean analyzable time was 95±11%. AF was detected in 82 (7.4%) participants, with AF burden (% time spent in AF) ranging from 0.1% to 100%, and the majority had long-standing, persistent AF. Participants with AF were older (74 vs 69 years, p&lt;0.001), had a higher prevalence of cardiovascular disease including prior MI and heart failure (48% versus 34%, p&lt;0.05); and had a higher body mass index (34 vs 32 kg/m 2 ; p&lt;0.05) than those without AF. NSVT occurred in 31% of participants, while no participant experienced sustained VT. High-degree AV block was present 2 participants (&lt;1%). Overall, pre-monitoring mean estimated glomerular filtration rate was 51±18 ml/min/1.73m2, and median urine albumin-to-creatinine ratio was 9.2 [4.4 - 44.6] mg/g. Kidney function or proteinturia were not independently associated with any of the arrhythmias. Conclusions: In adults with CKD undergoing 14-day continuous monitoring, AF was present in 1 in 14 indivduals, and nearly one-third had evidence of NSVT. Worsening kidney function was not independently associated with the prevalence of arrhythmias in this cohort. Future studies will need to assess the signficance of NSVT on cardiovascular events across the spectrum of CKD severity.